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Social Phobia

DSM-IV Diagnostic Criteria for Social Phobia

A marked and persistent fear of social or performance fobia situations in which the person is exposed to unfamiliar people or to scrutiny by others. The individual often fears that he will act in a way that will be humiliating or embarrassing.

Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a panic attack.

The person recognizes that the fear is excessive or unreasonable.

The feared situations are avoided or endured with intense distress.

The avoidance, anxious anticipation, or distress in the feared situations interferes with normal functioning or causes marked distress.

The duration of symptoms is at least six months.

The fear is caused by a substance or medical condition, and is not caused by another fobia.

If a medical condition or another mental disorder is present, the fear is unrelated (eg, the fear is not of trembling in a patient with Parkinson's disease).

Specify if the fear is generalized: The fear is generalized if the patient fears most social situations.

Clinical Features of Social Phobia

Patients often display hypersensitivity to criticism, difficulty being assertive, low self esteem, and inadequate social skills.

Avoidance of speaking in front of groups may lead to work or school difficulties. Most patients fear public speaking, while less than half fear meeting new people.

Less common fears include fear of eating, drinking, or writing in public, or of using a public restroom.

Epidemiology and Etiology

Lifetime prevalence is 3-13%.

Social phobia is more frequent in first degree relatives of patients with the disorder.

Onset usually occurs in adolescence, with a childhood history of shyness.

Social phobia is often a lifelong problem, but the disorder may remit or improve in adulthood.

Differential Diagnosis

Substance-Induced Anxiety Disorder. Substance